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The Impact of Genetic Testing for Type 2 Diabetes on Health Behaviors

2014-08-27 03:16:14 | BioPortfolio

Summary

In this 6-month randomized, controlled trial, we will evaluate the impact of genetic testing for type 2 diabetes on psychological, health behavior, and clinical outcomes. Results from this study will inform the VA whether genetic counseling can be effective for communicating disease risk, motivating behavior change, and, ultimately. preventing a complex, chronic disease (type 2 diabetes). If genetic risk counseling successfully augments conventional risk counseling, this study would provide a model for incorporating genetic testing for type 2 diabetes into primary care at the VA.

Description

Background:

T2DM is a debilitating, deadly, and costly chronic disease whose prevalence is increasing. Although the development of T2DM can be delayed or prevented by lifestyle changes, changes initiated too late may not delay T2DM onset indefinitely. Therefore, it is imperative to intervene earlier and to find new ways to increase motivation to initiate and maintain lifestyle changes.

Objectives:

New approaches to primary prevention could incorporate tests for genetic and genomic risk of T2DM, creating a sizable and growing opportunity for the translation of such tests into primary care and public health practice. However, the ability for these tests to demonstrate improvement in patients' health outcomes remains unknown, posing a major obstacle to further translation. In this 6-month randomized, controlled trial, we will evaluate the impact of genetic testing for T2DM on psychological, health behavior, and clinical outcomes.

Methods:

Eligibility criteria include age 21 to 65 years, overweight or obese (body mass index [BMI] >27 kg/m2), and no prior diagnosis of T2DM. At baseline, participants (N=600) will have conventional risk factors assessed, including demographics, fasting plasma glucose (FPG), and family history. They will also provide cheek tissue samples for genetic testing of TCF7L2, PPARG, and KCNJ11, three genes that confer elevated risk for development of T2DM. Participants will then be randomized to receive conventional counseling only (CR) or conventional counseling plus genetic test results (CR+G). One to two weeks following the baseline visit, when the genetic test results are available, participants will return for a visit with a genetic counselor. All participants will receive conventional risk counseling based on their lifetime population risk, FPG results, and family history. Next, participants will be informed of their randomization assignments; CR participants will receive general health risk counseling on issues unrelated to T2DM, whereas CR+G participants will receive genetic counseling. Then perceived risk, affect, self-efficacy, and readiness to change will be assessed. All other outcomes will be assessed at 3 and 6 months.

Status:

Enrollment scheduled to begin in early August, 2010.

Study Design

Allocation: Randomized, Intervention Model: Parallel Assignment, Masking: Single Blind (Outcomes Assessor), Primary Purpose: Prevention

Conditions

Diabetes Mellitus

Intervention

genetic testing for type 2 diabetes, Conventional risk counseling for type 2 diabetes

Location

VA Medical Center
Durham
North Carolina
United States
27705

Status

Not yet recruiting

Source

Department of Veterans Affairs

Results (where available)

View Results

Links

Published on BioPortfolio: 2014-08-27T03:16:14-0400

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The time period before the development of symptomatic diabetes. For example, certain risk factors can be observed in subjects who subsequently develop INSULIN RESISTANCE as in type 2 diabetes (DIABETES MELLITUS, TYPE 2).

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The joining of RNA from two different genes. One type of trans-splicing is the "spliced leader" type (primarily found in protozoans such as trypanosomes and in lower invertebrates such as nematodes) which results in the addition of a capped, noncoding, spliced leader sequence to the 5' end of mRNAs. Another type of trans-splicing is the "discontinuous group II introns" type (found in plant/algal chloroplasts and plant mitochondria) which results in the joining of two independently transcribed coding sequences. Both are mechanistically similar to conventional nuclear pre-mRNA cis-splicing. Mammalian cells are also capable of trans-splicing.

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